Strategic Work on the Future of the DSM
The American Psychiatric Association (APA) is revising the Diagnostic and Statistical Manual of Mental Disorders, the most widely used diagnostic tool in mental health. GMHAN is bringing lived expertise, critical scholarship, community practice and global perspectives into that revision, working directly with the APA and standing independent of it.
Why the DSM matters
The DSM is the Diagnostic and Statistical Manual of Mental Disorders. It is the most widely used and the most influential diagnostic tool for mental illness in the world, it has gone through several iterations and several rounds of criticism over the decades, and it is used extensively by psychiatrists in every region. Its reach goes well beyond the consultation room. The DSM sets norms and attitudes towards poor mental health from the point of view of the label, and by many accounts it remains highly problematic.
There is a simple way to put why this work matters to us. What is named is what is counted. The manual decides what gets named as a mental health problem, and what is named is then what gets coded, counted, funded, taught, insured and, in some countries, used in law. Influencing the DSM, and particularly bringing to it a social determinants, lived experience and global mental health advocacy point of view, could be some of the most meaningful influence we could ever have within the clinical care system.
The process, and the window
A Future DSM Strategic Committee was created by the APA in 2024, and it was charged with producing a road map for the next iteration of the manual. Subcommittees have been developed alongside it, including one on the social determinants of mental health.
The road map has now been published. It will be followed by a Taskforce that will do the work of actually revising the manual, and the new DSM will take several years to produce. This sequence is the reason we are working now. The structure is being settled before the drafting starts, and the decisions taken in this period will hold for decades, wherever clinical decisions are made about who gets what care. We have already been influencing the process.
Our position
The GMHAN Leadership Group has published a Position Statement on the future of the DSM, drawing on discussions at our Global Advocacy Forum in Iloilo City and on contributions from members across our regions. It sets out what we welcome in the road map, what we are asking the APA to change, and where we think the revision will fail if it is designed around a well-resourced consultation and exported afterwards.
Our objectives
To bring global perspectives and lived expertise into the revision at the point where decisions are being made, rather than after they have been made.
To shift the manual further towards the social and structural determinants of mental health, towards less medicalisation, and towards a framing that is more inclusive, more intersectional and more global.
To ensure that critiques, alternative frameworks, Mad Studies, critical scholarship and the acknowledgement of past and ongoing harm are part of the record of this revision.
To coordinate responses to APA consultations from the regions, communities and languages that an open call for comments will not reach.
To push to connect the conversation on the DSM with the ICD, given that most countries code, report and finance mental health care through the ICD.
To move underrepresented voices and perspectives from the margins to the mainstream of how distress is understood, named and classified.
How we are working
1. A Position Statement as our anchor. Our Position Statement reflects the plurality of our membership and serves as our response to the APA's published strategic papers, on which the Committee has invited feedback.
2. Consultation responses and regional papers. This work is led by critical and lived expertise and connects directly to the GMHAN Leadership Group. It brings together regional consultations, papers, and responses to the surveys and calls for comment as they are released.
3. A series of written pieces. We are curating writing on our website on alternative framings, on suicide as a diagnosis, on Indigenous perspectives, and on case studies from the field. There is already a rich body of work across Mad Studies, decolonial mental health, disability justice and community alternatives, and where things have been written well already we will signpost to and amplify the existing authors and activists.
Working with the APA, and standing independent
We are working with the APA. The Committee has asked for feedback on its road map and we have provided it, in detail and on the record, because we would rather be in the room while the structure is being decided than write about it once it is fixed.
We also stand independent in this effort. Our role is to represent the full diversity and expertise of the global mental health advocacy community, and that community holds positions ranging from incremental reform of the manual through to the abolition of diagnostic classification altogether. All of these perspectives have a place in our work.
A different future
GMHAN is uniquely positioned to bring together evidence, lived experience voices, and diverse global perspectives to explore these alternatives in meaningful and inclusive ways. By convening dialogue across disciplines, regions, and communities, GMHAN can support innovation and critical reflection on how mental health systems evolve. We believe that a different future is possible; one that embraces plurality of knowledge, recognises multiple pathways to care, and centres dignity, equity, and social justice in mental health systems.
Get in touch
Read our GMHAN Leadership Position Statement on the Future of the DSM
If you would like to discuss this work, or to contribute to our consultation responses, regional papers or written series, please contact: admin@gmhan.org
Members of the Global Mental Health Action Network can follow and shape this work through our Working Groups, our Circle platform and our webinars. Get involved and share your interests. We are inviting people to join our strategic groups all the time! Join us now